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Platelets

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Trauma Induced Coagulopathy

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Abstract

Traumatic bleeding is a clinical state that is (1) multifactorial with functional alterations in coagulation, fibrinolysis, complement, platelet, inflammation, and vascular parameters, (2) multiscale from molecule to cell to organ to multiorgan, and (3) dynamic from the moment of injury at an initial time t = 0 with a complex and patient-dependent trajectory. This chapter focuses on processes in the traumatic patient that impact platelet function. Platelet function and closely associated coagulation function are central to vascular integrity. The mechanisms and contributions of platelet dysfunction, either hypoactive or hyperactive, to trauma-induced coagulopathy (TIC) remain to be fully defined and prioritized. Identification of molecular changes within platelet signaling pathways leading to dysfunction allows the opportunity for pharmacological target identification relevant to TIC therapy. Finally, the laboratory or point-of-care assays to evaluate platelet function are reviewed. Importantly, successful hemostatic clotting under flow results in a 50 to 200-fold increase in platelet concentration within the hemostatic clot relative to whole blood, a biology that is difficult to recreate in a test tube under static conditions, but is accessible by microfluidic assay. This chapter reviews: (1) the extracellular modulators of platelet biology during trauma, (2) intracellular and autocrinic mechanisms of platelet dysfunction, and (3) diagnostic issues related to the measurement of platelet function in the trauma patient.

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Acknowledgments

The author thanks his collaborators and colleagues and students for many helpful and open discussions about platelet function, hemostasis, and trauma. This work was funded in part by NIH UM1 HL120877 TACTIC Consortium and NIH R01 HL103419 (SLD).

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Authors and Affiliations

  1. Department of Chemical and Biomolecular Engineering, Institute for Medicine and Engineering, University of Pennsylvania, 220 South 33rd St., Towne 311A, Philadelphia, PA, 19104-6393, USA

    Scott L. Diamond Ph.D.

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  1. Scott L. Diamond Ph.D.
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Correspondence to Scott L. Diamond Ph.D. .

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Editors and Affiliations

  1. Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado, USA

    Eduardo Gonzalez

  2. Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado, USA

    Hunter B. Moore

  3. Dept of Surgery & Trauma Research Center, Univ of Colorado Sch of Med&Denver Healt, Denver, Colorado, USA

    Ernest E. Moore

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Diamond, S.L. (2016). Platelets. In: Gonzalez, E., Moore, H., Moore, E. (eds) Trauma Induced Coagulopathy. Springer, Cham. https://doi.org/10.1007/978-3-319-28308-1_8

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  • DOI: https://doi.org/10.1007/978-3-319-28308-1_8

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